Racial bias in health care: an interview with Dr. Claudia Fegan

Mississippi Public Broadcasting Radio, April 29, 2013

PNHP note: The following is an unofficial transcript of an interview that took place in the studios of Mississippi Public Broadcasting in Jackson, Miss., on April 19. Dr. Claudia Fegan is past president of Physicians for a National Health Program. Her two-day visit to Jackson included presentations at Tougaloo College and the University of Mississippi Medical Center.

Karen Brown: This is Mississippi Edition on MPB Radio and I’m Karen Brown. The infant mortality rate among educated Black women is higher than among less-educated white women. So says Dr. Claudia Fegan, chief medical officer for Cook County, Illinois. Dr. Fegan was in Mississippi raising awareness on what she says is racial bias in the health care system. She tells us that, statistics aside, disparity in health care boils down to one thing.

Dr. Claudia Fegan: We’re talking about racism, and how racism impacts upon the delivery of health care in this country. Though we would like to pretend that we’re past that, that we’re in a post-racial state, the reality is that in the delivery of health care in this country racism still plays an important role.

KB: Is this Black and white, or is it Hispanic?

CF: It’s all of that. What we know is that people of color in this country, despite their economic status, are less likely to get the care they need. And until we wrap our brains around that, until we come to grips with that, we can’t begin to address the problem.

KB: Is the problem worse in the South, because everyone thinks that racism is more prevalent in the South?

CF: I can’t say that. The data shows that health care providers, be they Black or white, brown or yellow, in the delivery of health care, do not treat people of color the same. And, as a result of that, people of color do not always get the care that they need.

KB: What kind of data have you used to support that assertion?

CF: There’s very blunt data. The idea that Black women are less likely to get breast cancer than white women and yet their mortality rates are 32 percent higher than white women. There’s data that shows …

KB: Wait, I want to stop you there. Is it because Black women don’t seek out medical care, they don’t have access to medical care, or they’re under-treated or not diagnosed properly?

CF: All of those. So it’s a very complicated problem. If you look at the infant mortality rate, you'll find Black women with college degrees have births that do not have as good an outcome as white women who do not have a high school diploma. So it’s not as simple as socioeconomic status, and the notion that you can earn your way out, or educate your way out of these problems.

KB: That’s a very interesting statistic or example, because I have done many interviews with many experts talking about disparity and in particular about breast cancer being more deadly among Black women than among white women. The infant mortality rate is very high in this state, Mississippi, and I’ve never heard it said that an educated Black woman has a greater chance of having a child die in infancy than a white woman who is not educated.

CF: What I’m saying is that we as a country have not come to grips with all that is involved in the delivery of health care. So, for example, there’s something very important that’s happening between a patient and a physician. I’m boarded in quality; I look at quality a great deal. If you take a patient and a physician in the exam room, and then after that visit you talk to the physician about what he or she thinks happened in that room, and then talk to the patient about what they think happened in that room, there’s a great difference. There’s a gap there. And until we come to grips with that, we tend to focus on what we can quantify, but we need to understand that the way we are delivering health care does not meet the needs of the people to whom we’re trying to deliver it – we’re trying to care of people. Because that’s something we can’t count well. What we can count are things like death, morbidity, illness, complications – we can’t count that non-tangible part of that visit. What did we miss? Why is that when you look at the patient’s perception of what occurred, and the doctor’s perception of what occurred, there’s a disparity?

KB: How do you find that out?

CF: There are no simple answers, but the first thing you do is acknowledge that there’s a problem. That maybe what we’re delivering is not culturally competent care. That maybe we’re not meeting people where they are. Because, despite the amount of education we have, we still have our cultural bias. We still bring to the table whatever we were raised with, whatever we were brought up with.

KB: Tell me if this factors into it. Would a Black individual be likely to be more uncomfortable with a white doctor or a white person uncomfortable with a Black doctor?

CF: Well, that is the assumption. What you have to really understand is that if a … I heard someone yesterday say to me, “We don’t go to the County [hospital], because County care is not good care.” And if they’ve been raised with the impression that the care they would get there by a physician of color is not good and that they would be better served by a white doctor, then that’s where their comfort level is. That’s a bias that they bring to the table.

KB: And we should say that you’re coming at this from the doctor’s point of view, the health care institution’s point of view. You’re charging your fellow doctors to take this on, is that right?

CF: I’m charging society to take this on. Because while the doctors cannot – while we can lead, I would say we should participate. But we as a society have to accept the notion that everyone should have access to care. Everyone should have access to health care. We accept as a society that everyone should have access to education. We provide access to education. We accept the notion that we don’t expect a single individual to make sure that their water is clean. We as a society make sure they have clean water. We no longer expect someone, if there’s a fire in their house, to put it out by themselves. We realize that you need multiple hands.

KB: How do you focus on doctors who may be showing a bias toward patients? Is there a way, is there a program for doctors to address that or even to recognize that they might have a bias when it comes to treating their patients?

CF: Yes, there’s a wake-up moment: for people to think about the way in which they do their jobs every day, and even though they say I’ve done it this way every year for the last 20 years or 30 years. They’ve always had a reticence to do that.

KB: Let me wrap all this up by asking what, in your mind, is justice in health care?

CF: A patient being able to get what they need when they need it. I always ask: Who does not deserve health care? Is there someone you think who doesn’t deserve health care? And if they deserve health care, who does not deserve the best health care we have to deliver? And how can you ensure that everyone gets the best health care they deserve? And that’s by ensuring that everyone in this country is insured. And until we can guarantee every person coverage for the care they need, when they need it, we will not have justice in health care.

KB: Dr. Claudia Fegan is executive medical director for the Cook County Health and Hospital Systems. I thank you very much for being with us.